Search
coccygodynia
Pain in the region of or originating from the coccyx.
Etiology:
- any injury to the coccygeal region
- direct fall on the buttocks
Epidemiology:
- occurs with greater frequency in women
Pathology:
- injury that causes the coccyx to be tipped anteriorly, or deviated laterally, may cause the coccyx to become more mobile than normal
Physical examination:
- pelvic exam to rule out gynecologic disease
- bimanual rectal exam (see below)
Clinical manifestations:
- mobile &/or painful coccyx may be observed with bimanual exam with the index finger in the rectum and the other hand over the coccyx
Radiology:
- x-ray of pelvis, including coccyx
Management:
1) conservative management
- NSAIDs
- donut-shaped pillow or a gel cushion to decrease coccygeal pressure & local irritation
- hot sitz-type baths
- corticosteroid injections
- physiotherapeutically applied topical corticosteroid & analgesic combination (ultrasound phonophoresis or iontophoresis)
- acupuncture reflex therapy
- radiofrequency thermocoagulation after localizing painful sacral nerves with lidocaine injection
2) surgery
- coccygectomy
- limited coccygectomy involving only resection of the mobile or hypermobile segment of the coccyx, identified by fluoroscopy & local anesthetic injection prior to surgery
General
pain [odyn-]
References
- Lyons MJ
emedicine: Coccygodynia: Treatment
http://emedicine.medscape.com/article/1264763-treatment
- Coccygodynia
http://www.doctorsexercise.com/journal/coccygodynia.htm